Predictors of shoulder pain and disability index (SPADI) and work status after 1 year in patients with subacromial shoulder pain

Kaia Engebretsen, Margreth Grotle, Erik Bautz-Holter, Ole Marius Ekeberg, Jens Ivar Brox, Kaia Engebretsen, Margreth Grotle, Erik Bautz-Holter, Ole Marius Ekeberg, Jens Ivar Brox

Abstract

Background: Shoulder pain is a common complaint in primary health care and has an unfavourable outcome in many patients. The objectives were to identify predictors for pain and disability (SPADI) and work status in patients with subacromial shoulder pain.

Methods: Secondary analyses of data from a randomized clinical controlled trial were performed. Outcome measures were the absolute values of the combined Shoulder Pain and Disability Index (SPADI) and work status 1 year after treatment with supervised exercises (SE) or radial extracorporeal shockwave therapy (rESWT). Predictors of outcome were investigated using multiple linear regression (SPADI) and logistic regression (work status).

Results: 104 patients were included. Low education (≤ 12 years), previous shoulder pain, and a high baseline SPADI score predicted poor results with these variables explaining 29.9% of the variance in SPADI score at 1 year. Low education and poor self-reported health status predicted a work status of "not working": Odds Ratio, OR = 4.3(95% CI (1.3 to 14.9)), p = 0.02 for education, and OR = 1.06 (95% CI (1.0 to 1.1)), p = 0.001 for self-reported health status, respectively. Adjustments for age, gender, and treatment group were performed, but did not change the results.

Conclusion: Education was the most consistent predictor of pain and disability, and work status at 1 year follow-up. Also, baseline SPADI score, previous shoulder pain and self-reported health status predicted outcome.

Trial registration: Clinical trials NCT00653081.

Figures

Figure 1
Figure 1
Flow chart of the study.

References

    1. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, Verhaar JA. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33:73–81. doi: 10.1080/03009740310004667.
    1. Bongers PM. The cost of shoulder pain at work. BMJ. 2001;322:64–65. doi: 10.1136/bmj.322.7278.64.
    1. Kuijpers T, van der Heijden GJ, Vergouwe Y, Twisk JW, Boeke AJ, Bouter LM, van der Windt DA. Good generalizability of a prediction rule for prediction of persistent shoulder pain in the short term. J Clin Epidemiol. 2007;60:947–953. doi: 10.1016/j.jclinepi.2006.11.015.
    1. Croft P, Pope D, Silman A. The clinical course of shoulder pain: prospective cohort study in primary care. Primary Care Rheumatology Society Shoulder Study Group. BMJ. 1996;313:601–602.
    1. van der Windt DA, Koes BW, Boeke AJ, Deville W, De Jong BA, Bouter LM. Shoulder disorders in general practice: prognostic indicators of outcome. Br J Gen Pract. 1996;46:519–523.
    1. Lakke SE, Soer R, Takken T, Reneman MF. Risk and prognostic factors for non-specific musculoskeletal pain: a synthesis of evidence from systematic reviews classified into ICF dimensions. Pain. 2009;147:153–164. doi: 10.1016/j.pain.2009.08.032.
    1. Mallen CD, Peat G, Thomas E, Dunn KM, Croft PR. Prognostic factors for musculoskeletal pain in primary care: a systematic review. Br J Gen Pract. 2007;57:655–661.
    1. Miranda H, Viikari-Juntura E, Martikainen R, Takala EP, Riihimaki H. A prospective study of work related factors and physical exercise as predictors of shoulder pain. Occup Environ Med. 2001;58:528–534. doi: 10.1136/oem.58.8.528.
    1. Kennedy CA, Manno M, Hogg-Johnson S, Haines T, Hurley L, McKenzie D, Beaton DE. Prognosis in soft tissue disorders of the shoulder: predicting both change in disability and level of disability after treatment. Phys Ther. 2006;86:1013–1032.
    1. Kuijpers T, van der Windt D, van der Heijden G. Systematic review of prognostic cohort studies on shoulder disorders. Spine. 2004;109:420–431.
    1. Kuijpers T, van der Windt DA, Boeke AJ, Twisk JW, Vergouwe Y, Bouter LM, van der Heijden GJ. Clinical prediction rules for the prognosis of shoulder pain in general practice. Pain. 2006;120:276–285. doi: 10.1016/j.pain.2005.11.004.
    1. Marhold C, Linton SJ, Melin L. Identification of obstacles for chronic pain patients to return to work: evaluation of a questionnaire. J Occup Rehabil. 2002;12:65–75. doi: 10.1023/A:1015056429505.
    1. Brox JI, Brevik JI. Prognostic factors in patients with rotator tendinosis (stage II impingement syndrome) of the shoulder. Scand J Prim Health Care. 1996;14:100–105. doi: 10.3109/02813439608997078.
    1. Brox JI, Gjengedal E, Uppheim G, Bohmer AS, Brevik JI, Ljunggren AE, Staff PH. Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomized, controlled study in 125 patients with a 2 1/2-year follow-up. J Shoulder Elbow Surg. 1999;8:102–111. doi: 10.1016/S1058-2746(99)90001-0.
    1. Engebretsen K, Grotle M, Bautz-Holter E, Sandvik L, Juel NG, Ekeberg OM, Brox JI. Radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single blind randomised study. BMJ. 2009;339:b3360. doi: 10.1136/bmj.b3360.
    1. Engebretsen K, Grotle M, Bautz-Holter E, Sandvik L, Juel NG, Ekeberg OM, Brox JI. Supervised Exercises (SE) compared with radial Extracorporeal Shockwave Therapy (rESWT) for patients with subacromial shoulder pain. 1-year results of a clinical controlled randomized study. 2010.
    1. Bot SD, van der Waal JM, Terwee CB, van der Windt DA, Scholten RJ, Bouter LM, Dekker J. Predictors of outcome in neck and shoulder symptoms: a cohort study in general practice. Spine. 2005;30:E459–E470. doi: 10.1097/01.brs.0000174279.44855.02.
    1. Beattie PF, Nelson RM. Evaluating research studies that address prognosis for patients receiving physical therapy care: a clinical update. Phys Ther. 2007;87:1527–1535. doi: 10.2522/ptj.20060284.
    1. Reilingh ML, Kuijpers T, Tanja-Harfterkamp AM, van der Windt DA. Course and prognosis of shoulder symptoms in general practice. Rheumatology (Oxford) 2008;47:724–730. doi: 10.1093/rheumatology/ken044.
    1. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974;19:1–15. doi: 10.1002/bs.3830190102.
    1. Brooks R. EuroQol: the current state of play. Health Policy. 1996;37:53–72. doi: 10.1016/0168-8510(96)00822-6.
    1. Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum. 1989;32:37–44. doi: 10.1002/anr.1780320107.
    1. Brox JI, Staff PH, Ljunggren AE, Brevik JI. Artroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome) BMJ. 1993;307:899–903. doi: 10.1136/bmj.307.6909.899.
    1. Triffitt PD, Wildin C, Hajioff D. The reproducibility of measurement of shoulder movement. Acta Orthop Scand. 1999;70:322–324. doi: 10.3109/17453679908997817.
    1. Paul A, Lewis M, Shadforth MF, Croft PR, van der Windt DA, Hay EM. A comparison of four shoulder-specific questionnaires in primary care. Ann Rheum Dis. 2004;63:1293–1299. doi: 10.1136/ard.2003.012088.
    1. Ekeberg OM, Bautz-Holter E, Tveita EK, Keller A, Juel NG, Brox JI. Agreement, reliability and validity in 3 shoulder questionnaires in patients with rotator cuff disease. BMC Musculoskelet Disord. 2008;9:68–77. doi: 10.1186/1471-2474-9-68.
    1. Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res. 1991;4:143–149. doi: 10.1002/art.1790040403.
    1. Sauerbrei W, Royston P, Binder H. Selection of important variables and determination of functional form for continuous predictors in multivariable model building. Stat Med. 2007;26:5512–5528. doi: 10.1002/sim.3148.
    1. Pallant J. SPSS survival manual a step by step guide to data analysing using SPSS for Windows. Maidenhead: McGraw-Hill Open University Press; 2007.
    1. Macfarlane GJ, Hunt IM, Silman AJ. Predictors of chronic shoulder pain: a population based prospective study. J Rheumatol. 1998;25:1612–1615.
    1. Furnee CA, Groot W, van den Brink HM. The health effects of education: a meta-analysis. Eur J Public Health. 2008;18:417–421. doi: 10.1093/eurpub/ckn028.
    1. Zheng Z, Simpson JA, van der Windt D, Elliott AM. Data from a study of effectiveness suggested potential prognostic factors related to the patterns of shoulder pain. Journal of Clinical Epidemiology. 2005;58:823–830. doi: 10.1016/j.jclinepi.2005.01.011.
    1. Hagen KB, Tambs K, Bjerkedal T. What mediates the inverse association between education and occupational disability from back pain?--A prospective cohort study from the Nord-Trondelag health study in Norway. Soc Sci Med. 2006;63:1267–1275. doi: 10.1016/j.socscimed.2006.03.041.
    1. Dionne CE, Von KM, Koepsell TD, Deyo RA, Barlow WE, Checkoway H. Formal education and back pain: a review. J Epidemiol Community Health. 2001;55:455–468. doi: 10.1136/jech.55.7.455.
    1. Werner EL, Cote P. Low back pain and determinants of sickness absence. Eur J Gen Pract. 2009;15:74–79. doi: 10.1080/13814780903051866.
    1. Grooten WJ, Mulder M, Josephson M, Alfredsson L, Wiktorin C. The influence of work-related exposures on the prognosis of neck/shoulder pain. Eur Spine J. 2007;16:2083–2091. doi: 10.1007/s00586-007-0481-0.
    1. Haldorsen EM, Grasdal AL, Skouen JS, Risa AE, Kronholm K, Ursin H. Is there a right treatment for a particular patient group? Comparison of ordinary treatment, light multidisciplinary treatment, and extensive multidisciplinary treatment for long-term sick-listed employees with musculoskeletal pain. Pain. 2002;95:49–63. doi: 10.1016/S0304-3959(01)00374-8.
    1. Holtermann A, Hansen JV, Burr H, Sogaard K. Prognostic factors for long-term sickness absence among employees with neck-shoulder and low-back pain. Scand J Work Environ Health. 2010;36:34–41.
    1. Park HB, Yokota H, Gill HS, El Rassi G, McFarland EG. Diagnostic Accuracy of Clinical Tests for the Different Degrees of Subacromial Impingement Syndrome. Journal of Bone Joint Surgery. 2005;87:1446–1455. doi: 10.2106/JBJS.D.02335.
    1. Cloke D, Lynn S, Watson H. A comparison of functional, patient-based scores in subacromial impingement. Journal of Shoulder and Elbow Surgery. 2005;14:380–384. doi: 10.1016/j.jse.2004.08.008.
    1. MacDermid JC, Solomon P, Prkachin K. The Shoulder Pain and Disability Index demonstrates factor, construct and longitudinal validity. BMC Musculoskelet Disord. 2006;7:12. doi: 10.1186/1471-2474-7-12.
    1. Ostor AJ, Richards CA, Prevost AT, Hazleman BL, Speed CA. Interrater reproducibility of clinical tests for rotator cuff lesions. Ann Rheum Dis. 2004;63:1288–1292. doi: 10.1136/ard.2003.014712.
    1. Royston P, Moons KG, Altman DG, Vergouwe Y. Prognosis and prognostic research: Developing a prognostic model. BMJ. 2009;338:b604. doi: 10.1136/bmj.b604.
    1. Altman DG, Vergouwe Y, Royston P, Moons KG. Prognosis and prognostic research: validating a prognostic model. BMJ. 2009;338:b605. doi: 10.1136/bmj.b605.
    1. Moons KG, Altman DG, Vergouwe Y, Royston P. Prognosis and prognostic research: application and impact of prognostic models in clinical practice. BMJ. 2009;338:b606. doi: 10.1136/bmj.b606.
    1. Hancock M, Herbert RD, Maher CG. A guide to interpretation of studies investigating subgroups of responders to physical therapy interventions. Phys Ther. 2009;89:698–704. doi: 10.2522/ptj.20080351.
    1. Moons KG, Royston P, Vergouwe Y, Grobbee DE, Altman DG. Prognosis and prognostic research: what, why, and how? BMJ. 2009;338:b375. doi: 10.1136/bmj.b375.
    1. Grotle M, Vollestad NK, Veierod MB, Brox JI. Fear-avoidance beliefs and distress in relation to disability in acute and chronic low back pain. Pain. 2004;112:343–352. doi: 10.1016/j.pain.2004.09.020.

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